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Stress Management for Allied Health Professionals

Richard Gevirtz, Ph.D.

CSPP@Alliant International University-San Diego

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Theme of the presentation

• Understanding the underlying physiology of stress is useful in managing it.

• “If our brain was simple enough for us to understand, we would be too dumb to understand it”

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What is Stress?

• Stimulus– Work

– Time

– People

– Conflicting demands

• Response– Physiological

• Autonomic

• Central

• Endocrine

• Respiratory

– Psychological• Anxiety

• Depression

– Behavioral

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Interactional Models of Stress

• Perception/appraisal

• Physiological Mediators

• Phenomenological experiences

• Responses

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Nature of Modern Stressors

• Few require massive mobilization (fight/flight)

• Most involve interpersonal challenges, social hierarchies, rejection/acceptance

• Often characterized by internal rumination and worry states; anticipatory anxiety

• Strong involvement of negative or critical self-judgement

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Raymond puts and end to his critical inner dialog.

New Trends Cognitive Therapy

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Physiology of Stress

• Four most important systems:– Sympathetic Nervous System/Adrenal Medullary

system• Fight/Flight/Fright

– Parasympathetic Nervous System• Rest/Digest

– Hypothalamic Pituitary System• Cortisol

– Respiratory System• Hyperventilation

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Parasympathetic (PSNS) Activity

• Parasympathetic activity:– Decreases heart rate, polarizes cells.

– Acts through acetylcholine, high turnover in cells means beat-to-beat regulation.

– Acts to stabilize the cardiac membrane and re-establish homeostasis.

– Usually exceeds SNS activity.

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Phylogenetic Hierarchy in Cardiovascular Response to Stress

Chromaffin DMNX SNS Adrenal Med NA

Cyclostomes ⇑

Cartilaginous fish ⇑ ⇑

Advanced fish ⇑ ⇓ ⇑

Amphibians ⇑ ⇓ ⇑

Reptiles ⇑ ⇓ ⇑ ⇑

Mammals * ⇑ ⇓ ⇑ ⇑ ⇓

*Allows rapid regulation of

metabolic output:useful in social regulation

*Allows rapid regulation of

metabolic output:useful in social regulation

DMNX=dorsal motor nucleus

SNS=sympathetic nervous system

NA= nucleus ambiguous

DMNX=dorsal motor nucleus

SNS=sympathetic nervous system

NA= nucleus ambiguous

Immobilization, death feigning, passive avoidance, shutdown.

Unmyelinatedvagus(dorsal vagal complex)

I

Mobilization, fight/flight, active avoidance

Sympathetic-adrenal-system(sympathetic nervous system)

II

Social communication, self-soothing and calming, inhibit symp-adrenal-influences

Myelinated vagus(ventral vagal complex)

III

Behavioral Component

ANS ComponentStage

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Vagal Withdrawal: An alternative to Sympathetic Activation

• .: Neurosci Biobehav Rev. 1995 Summer;19(2):225-33.

–Cardiac vagal tone: a physiological index of stress.

Porges SW.

Institute for Child Study, University of Maryland, College Park 20742, USA.

Cardiac vagal tone is proposed as a novel index of stress and stress vulnerability in mammals. A model is described that emphasizes the role of the parasympathetic nervous system and particularly the vagus nerve in defining stress. The model details the importance of a branch of the vagus originating in the nucleus ambiguus. In mammals the nucleus ambiguus not only coordinates sucking, swallowing, and breathing, but it also regulates heart rate and vocalizations in response to stressors. In mammals it is possible, by quantifying the amplitude of respiratory sinus arrhythmia, to assess the tonic and phasic regulation of the vagal pathways originating in the nucleus ambiguus. Measurement of this component of vagal tone is proposed as a method to assess, on an individual basis, both stress and the vulnerability to stress.

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Worrying about being late for an appointment. See FFT B

Driving. See FFT A

13 Br/Min

33 Br/min

Anxiety attack while driving home

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“As a consequence of hyperventilation, the decrease in PCO2 will reduce the caliber of the arteries and thereby impede the flow of blood to body tissue (ischemia), and the increase in blood pH will reduce the amount of oxygen that hemoglobin can release to the body tissue (hypoxia). Therefore, the heart must pump more frequently and with greater vigor in order to compensate for the decrease in pCO2 and increase in pH.” { Ley, 1987, p.309}

This is your brain on normal breathing.

This is your brainon hyperventilation.

Low blood flow High blood flow

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Stress Management

• Using our knowledge of stress physiology

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Stress Management Approaches IPhysiological

• Exercise

• Nutrition

• Mind/Body Techniques– Yoga

– Tai Chi\

– Mindfulness Meditation

– Breathing

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60

65

70

75

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1 12 23 34 45 56 67 78 89 100

111

122

133

144

155

166

177

188

Time (sec)

Hea

rt R

ate

(bea

t/min

)

Biofeedback Rest

EFFECTS OF HRV BIOFEEDBACK ON HEART RATE

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ValleyPacer set at 7.0 bpm

Respiration

Heart Rate

Peak= 79

Valley= 63

StressEraser.com

HeartMath.Com

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Stress Management Techniques II: Cognitive

• Reframing/ humor• Decatastrophizing• Reducing the duration of “stress attacks”

– Acceptance of flawed self– Acceptance of early engrams– Reduction of duration– Experiential avoidance can’t work

• Cognitive workbooks (Ex. Mind over Mood) • Get Out of your Mind and into your Life-

Hayes